Guest guest Posted September 19, 2001 Report Share Posted September 19, 2001 A patient has had a prostate procedure called a TUNA (transurethral needle application), and now about 2 1/2 months later, complains of a decreased amount of penile sensation during intercourse. I suspect this is from scar tissue. By the way, the procedure didn't work. He is still urinating a lot and on top of that, enjoying sex less. He is 50 years old and, other than his prostate, has no major problems. He sees me for acupuncture once a month. Does anyone have any suggestions for a formula that could help him regain or improve penile sensation? Thanks. Frances Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2001 Report Share Posted September 19, 2001 Frances, While doing research for an upcoming book on Chinese sexual culture, we came across a large number of formulas that might be useful in this case. But before I could point you at one or the other, You'd need to provide a more complete picture of the case. Your presumption that the loss of sensation stems from scar tissue may or may not be accurate and/or complete, as the symptom you describe could also stem from the underlying pattern. So you should provide other pertinent details. You say he enjoys sex less. Why is that? What specifically contributes to his lack of enjoyment? Is he anxious about how he performs? Does he have problems getting or sustaining an erection? Has he become less or non-orgasmic? How often does he have sex? Has the frequency of sexual activity increased? decreased? How has this all affected his relationship if indeed he is in a relationship? Are there emotional issues with his sex partner? Again, what are the details? Like I said, there is a range of formulas that can be applied to cases of this category. I'm just curious to know a little more before heading for the herb cabinet. What is the condition of his prostate? If enlarged, how much? And how long has the problem been going on? When was it first diagnosed? Did it come on gradually or was the onset of symptoms more sudden? Is that what you were treating him for with acupuncture? I'm also curious as to why you've been seeing him only once a month. I also note that you mention he has no other major problems. Does this mean he is having minor problems? If so, what are they? Best, Ken -- In , Frances Gander <fgander@c...> wrote: > > A patient has had a prostate procedure called a TUNA (transurethral > > needle application), and now about 2 1/2 months later, complains of a > > decreased amount of penile sensation during intercourse. I suspect > > this is from scar tissue. By the way, the procedure didn't work. He > > is still urinating a lot and on top of that, enjoying sex less. He is > > 50 years old and, other than his prostate, has no major problems. He > > sees me for acupuncture once a month. Does anyone have any > > suggestions for a formula that could help him regain or improve penile > > sensation? Thanks. > > Frances > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2001 Report Share Posted September 20, 2001 Will, Here are some details on this fellow. Tongue: swollen body and red edges, thin coat Pulses: thick feeling on right side sometimes, large, round shape middle position on left can be tight, excess both distal positions tend to be relatively deficient odd quality on rt. proximal position, usually relatively deficient overall, pulses often feel pounding and phlegmy, esp. on right Lifestyle: He is an attorney with a busy practice. Lives with his wife and her teen-age daughter by a previous marriage. He and his wife take several major vacations a year; e.g. Venice, the Galapagos, etc. He is concerned about his physique and weight loss and exercises rigorously every day--1/2 hour twice daily on Nordic Trak and crunches and push-ups. When he comes in, he unloads everything about what's going on at his office, in town, at home, sex, whatever. Complaints: Initially he came in with hip pain from running which was easily treated, states that this treatment got rid of his allergies as well. I find his neck/shoulder area always are very tight (upper trapezius and SCM). When under tension at work, he clenches his jaw and sometimes gets tension headaches with stabbing pain. So I usually do some acupressure. He had a reflux problem for a while which responded to xiao jian zhong tang, but he stopped taking them after his doctor put him on Prilosec. Lately he has weaned himself off the Prilosec and hasn't had further episodes. These incidents of reflux seemed related to anxiety while at business luncheons or other social/business functions with food, average of once a week. The food was often of the greasy, heavy type, probably some alcohol, too. The food would suddenly back up and he'd have to run to the bathroom to vomit. He first mentioned the elevated PSA in '96 and was referred to a urologist who put him on Orantin (sp?) and later Hytrin. The latter helped his flow, but he still got up 2-3 times a night to urinate. He has insomnia, of the type of waking up several times and not being able to go right back to sleep. I gave him gui pi wan but he reduced the dosage and then stopped taking it. It was helping when he took what I recommended. Occasionally he has hemorrhoids with or without leakage, sometimes diarrhea and loose stool. He mentioned that the hemorrhoids and frequent urination tend to go together. Blood pressure and cholesterol tend to be high. In regard to his sexuality, he said he was enjoying sex less than he did before the TUNA procedure. Prostate problems came on gradually since about '96. Most of the time I do not treat him specifically for his prostate problem. I plan his treatments around getting rid of phlegm, relaxing him, and balancing out the liver-spleen disharmony. Quite a lot of yang ming points. His prostate was slightly enlarged and he had an elevated PSA, which the urologist said this procedure most likely would remedy. He states that he had no problem with getting and sustaining erection and that his wife was having orgasm(s). The problem, to him is that he doesn't have the same sensation that he used to. It doesn't feel as exciting, although functionallly and orgasmically, everything's o.k. He says his orgasms are less satisfying because of decreased penile sensation. They have sex a couple of times a week, which is their usual frequency. While on vacation, they have sex more often. He seems to have a healthy relationship with his wife. They enjoy life together. Her teen-age daughter may be a source of aggravation. Anything I didn't cover? Hope this helps your understanding. Thanks Frances yulong wrote: Frances, While doing research for an upcoming book on Chinese sexual culture, we came across a large number of formulas that might be useful in this case. But before I could point you at one or the other, You'd need to provide a more complete picture of the case. Your presumption that the loss of sensation stems from scar tissue may or may not be accurate and/or complete, as the symptom you describe could also stem from the underlying pattern. So you should provide other pertinent details. You say he enjoys sex less. Why is that? What specifically contributes to his lack of enjoyment? Is he anxious about how he performs? Does he have problems getting or sustaining an erection? Has he become less or non-orgasmic? How often does he have sex? Has the frequency of sexual activity increased? decreased? How has this all affected his relationship if indeed he is in a relationship? Are there emotional issues with his sex partner? Again, what are the details? Like I said, there is a range of formulas that can be applied to cases of this category. I'm just curious to know a little more before heading for the herb cabinet. What is the condition of his prostate? If enlarged, how much? And how long has the problem been going on? When was it first diagnosed? Did it come on gradually or was the onset of symptoms more sudden? Is that what you were treating him for with acupuncture? I'm also curious as to why you've been seeing him only once a month. I also note that you mention he has no other major problems. Does this mean he is having minor problems? If so, what are they? Best, Ken -- In , Frances Gander <fgander@c...> wrote: > > A patient has had a prostate procedure called a TUNA (transurethral > > needle application), and now about 2 1/2 months later, complains of a > > decreased amount of penile sensation during intercourse. I suspect > > this is from scar tissue. By the way, the procedure didn't work. He > > is still urinating a lot and on top of that, enjoying sex less. He is > > 50 years old and, other than his prostate, has no major problems. He > > sees me for acupuncture once a month. Does anyone have any > > suggestions for a formula that could help him regain or improve penile > > sensation? Thanks. > > Frances > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2001 Report Share Posted September 21, 2001 Frances, The formulas I had in mind don't match the conditions you describe. Sounds like a handfull. Good luck. Ken (Will has a beard) , Frances Gander <fgander@c...> wrote: > Will, > > Here are some details on this fellow. > > Tongue: swollen body and red edges, thin coat > Pulses: thick feeling on right side sometimes, large, round shape > middle position on left can be tight, excess > both distal positions tend to be relatively deficient > odd quality on rt. proximal position, usually relatively > deficient > overall, pulses often feel pounding and phlegmy, esp. on > right > > Lifestyle: He is an attorney with a busy practice. Lives with his wife > and her teen-age daughter by a previous marriage. He and his wife take > several major vacations a year; e.g. Venice, the Galapagos, etc. He is > concerned about his physique and weight loss and exercises rigorously > every day--1/2 hour twice daily on Nordic Trak and crunches and > push-ups. When he comes in, he unloads everything about what's going on > at his office, in town, at home, sex, whatever. > > Complaints: Initially he came in with hip pain from running which was > easily treated, states that this treatment got rid of his allergies as > well. I find his neck/shoulder area always are very tight (upper > trapezius and SCM). When under tension at work, he clenches his jaw and > sometimes gets tension headaches with stabbing pain. So I usually do > some acupressure. He had a reflux problem for a while which responded > to xiao jian zhong tang, but he stopped taking them after his doctor put > him on Prilosec. Lately he has weaned himself off the Prilosec and > hasn't had further episodes. These incidents of reflux seemed related > to anxiety while at business luncheons or other social/business > functions with food, average of once a week. The food was often of the > greasy, heavy type, probably some alcohol, too. The food would suddenly > back up and he'd have to run to the bathroom to vomit. He first > mentioned the elevated PSA in '96 and was referred to a urologist who > put him on Orantin (sp?) and later Hytrin. The latter helped his flow, > but he still got up 2-3 times a night to urinate. He has insomnia, of > the type of waking up several times and not being able to go right back > to sleep. I gave him gui pi wan but he reduced the dosage and then > stopped taking it. It was helping when he took what I recommended. > Occasionally he has hemorrhoids with or without leakage, sometimes > diarrhea and loose stool. He mentioned that the hemorrhoids and > frequent urination tend to go together. Blood pressure and cholesterol > tend to be high. > > In regard to his sexuality, he said he was enjoying sex less than he did > before the TUNA procedure. Prostate problems came on gradually since > about '96. Most of the time I do not treat him specifically for his > prostate problem. I plan his treatments around getting rid of phlegm, > relaxing him, and balancing out the liver-spleen disharmony. Quite a > lot of yang ming points. His prostate was slightly enlarged and he had > an elevated PSA, which the urologist said this procedure most likely > would remedy. He states that he had no problem with getting and > sustaining erection and that his wife was having orgasm(s). The > problem, to him is that he doesn't have the same sensation that he used > to. It doesn't feel as exciting, although functionallly and > orgasmically, everything's o.k. He says his orgasms are less satisfying > because of decreased penile sensation. They have sex a couple of times > a week, which is their usual frequency. While on vacation, they have sex > more often. He seems to have a healthy relationship with his wife. > They enjoy life together. Her teen-age daughter may be a source of > aggravation. > > Anything I didn't cover? Hope this helps your understanding. Thanks > > Frances > > yulong@m... wrote: > > > Frances, > > > > While doing research for an upcoming book on > > Chinese sexual culture, we came across a large > > number of formulas that might be useful in > > this case. But before I could point you at > > one or the other, You'd need to provide > > a more complete picture of the case. > > > > Your presumption that the loss of sensation > > stems from scar tissue may or may not be > > accurate and/or complete, as the symptom you > > describe could also stem from the underlying pattern. > > > > So you should provide other pertinent details. > > > > You say he enjoys sex less. Why is that? > > What specifically contributes to his lack > > of enjoyment? Is he anxious about how he > > performs? Does he have problems getting > > or sustaining an erection? Has he become > > less or non-orgasmic? > > > > How often does he have sex? Has the frequency > > of sexual activity increased? decreased? > > > > How has this all affected his relationship > > if indeed he is in a relationship? Are > > there emotional issues with his sex partner? > > > > Again, what are the details? > > > > Like I said, there is a range of formulas > > that can be applied to cases of this category. > > I'm just curious to know a little more > > before heading for the herb cabinet. > > > > What is the condition of his prostate? > > If enlarged, how much? And how long has > > the problem been going on? When was it > > first diagnosed? Did it come on gradually > > or was the onset of symptoms more sudden? > > > > Is that what you were treating him for > > with acupuncture? > > > > I'm also curious as to why you've been > > seeing him only once a month. > > > > I also note that you mention he has no > > other major problems. Does this mean he > > is having minor problems? If so, what > > are they? > > > > Best, > > > > Ken > > > > -- In , Frances Gander <fgander@c...> wrote: > > > > A patient has had a prostate procedure called a TUNA > > (transurethral > > > > needle application), and now about 2 1/2 months later, complains > > of a > > > > decreased amount of penile sensation during intercourse. I > > suspect > > > > this is from scar tissue. By the way, the procedure didn't > > work. He > > > > is still urinating a lot and on top of that, enjoying sex less. > > He is > > > > 50 years old and, other than his prostate, has no major > > problems. He > > > > sees me for acupuncture once a month. Does anyone have any > > > > suggestions for a formula that could help him regain or improve > > penile > > > > sensation? Thanks. > > > > > > Frances > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2001 Report Share Posted September 21, 2001 Frances, Sensation is one of the basic functions of the skin no matter where that skin is located. The functions of the skin are dependent on two basic things: 1) unimpeded qi flow to and through the area, and 2) sufficient nourishment and moistening by blood and fluids. Further, qi flow to and through an area may be inadequate for either two reasons: 1) qi vacuity or insufficiency, and 2) something blocking and obstructing the flow of qi. Given this patient's age, symptoms, and history plus Chinese medical theory in general and nan ke theory in particular (nan ke is the speciality in male urogenital conditions), it is probable that, besides the liver-spleen/liver-stomach/stomach-intestines disharmonies you have identified, there is also some combination of phlegm and blood stasis, and either of these can obstruct the flow of qi and blood to and through the penis resulting in abnormal or diminished function, including sensation. In addition, I think you need to clarify just how much qi vacuity there is and whether or not there is concomitant damp heat, a common complicating factor in men with this kind of condition. You should be able to use the hemorrhoids to tell you about the role of qi vacuity and damp heat in the lower burner in this scenario. Are the hemorrhoids characteristic of or associated with qi vacuity falling downward? Are there any symptoms of damp heat, such as anal burning, aggravation due to hot, spicy, greasy, fatty foods and alcohol? The color of the urination during episodes of hemorrhoids and the color, consistency, smell, force of evacuation, and feeling of any diarrhea should also help tell you about the relative proportions of qi vacuity to damp heat. Once you have determined the relative proportions of these elements (at least as an initial hypothesis), I recommend that you look at A Handbook of TCM Urology & Male Sexual Dysfunction by Anna Lin and the Recent Research Reports published by Blue Poppy on prostatic hypertrophy. I think BPP also publishes a Research Report on post-TURP incontinence which might help you understand the disease mechanisms resulting from the TUNA procedure. Clearly from your description, whatever the mechanisms causing the BPH and any other mechanisms associated with the surgical procedure are involved with the loss of penile sensation. Similarly, you should also look at formulas for frequent urination, diarrhea, and hemorrhoids in basic nei ke or internal medicine texts, since the disease mechanisms of these conditions are also associated with whatever is going on (or not going on) in the penis. The various formulas that you find in these sources can then be used as models for writing a prescription for your patient. I say models because you will probably not find a formula " ready-to-go " as is that exactly matches your patient's personal combination of patterns and presenting symptoms. However, the formulas in these sources should give you a good idea of the medicinals which are empirically known to work on and are commonly used by well experienced practitioners to treat this area of the body. Within contemporary Chinese medicine, nan ke or the specialty in male urogential conditions is a hot topic. There are many books available in Chinese on this specialty. In addition, articles on the Chinese medical treatment of BPH are routine in almost every issue of every Chinese provincial and college Chinese medical journal. Given the aging of the population, this is a great area to specialize in. Thanks for sharing this case with the participants of this discussion group. It's great that you were able to effectively treat this man's hip pain and allergies. I believe that you should be able to craft a single formula that does take into account most, if not all, of your patient's symptoms and the disease mechanisms that are causing them. It should not be difficult to see how a wood-earth disharmony can then cause blood stasis, phlegm, and/or damp heat in the lower burner. Although this man's symptoms may seem complex, the presentation you describe is not all that uncommon in my experience. In fact, this guy seems pretty representative to me of Western patients his age. These are exactly the kinds of patients we have to deal with here in the U.S., and it is my experience that it is the process or methodology of Chinese medicine that is the key to dealing with such cases. Ultimately, it is my experience that these kinds of complicated cases require the crafting of individual formulas (granted, perhaps from published antecedents), and it is the problem-solving process of professional Chinese medicine that allows us to do just that. Good luck and best wishes. Sincerely, Bob , Frances Gander <fgander@c...> wrote: > Will, > > Here are some details on this fellow. > > Tongue: swollen body and red edges, thin coat > Pulses: thick feeling on right side sometimes, large, round shape > middle position on left can be tight, excess > both distal positions tend to be relatively deficient > odd quality on rt. proximal position, usually relatively > deficient > overall, pulses often feel pounding and phlegmy, esp. on > right > > Lifestyle: He is an attorney with a busy practice. Lives with his wife > and her teen-age daughter by a previous marriage. He and his wife take > several major vacations a year; e.g. Venice, the Galapagos, etc. He is > concerned about his physique and weight loss and exercises rigorously > every day--1/2 hour twice daily on Nordic Trak and crunches and > push-ups. When he comes in, he unloads everything about what's going on > at his office, in town, at home, sex, whatever. > > Complaints: Initially he came in with hip pain from running which was > easily treated, states that this treatment got rid of his allergies as > well. I find his neck/shoulder area always are very tight (upper > trapezius and SCM). When under tension at work, he clenches his jaw and > sometimes gets tension headaches with stabbing pain. So I usually do > some acupressure. He had a reflux problem for a while which responded > to xiao jian zhong tang, but he stopped taking them after his doctor put > him on Prilosec. Lately he has weaned himself off the Prilosec and > hasn't had further episodes. These incidents of reflux seemed related > to anxiety while at business luncheons or other social/business > functions with food, average of once a week. The food was often of the > greasy, heavy type, probably some alcohol, too. The food would suddenly > back up and he'd have to run to the bathroom to vomit. He first > mentioned the elevated PSA in '96 and was referred to a urologist who > put him on Orantin (sp?) and later Hytrin. The latter helped his flow, > but he still got up 2-3 times a night to urinate. He has insomnia, of > the type of waking up several times and not being able to go right back > to sleep. I gave him gui pi wan but he reduced the dosage and then > stopped taking it. It was helping when he took what I recommended. > Occasionally he has hemorrhoids with or without leakage, sometimes > diarrhea and loose stool. He mentioned that the hemorrhoids and > frequent urination tend to go together. Blood pressure and cholesterol > tend to be high. > > In regard to his sexuality, he said he was enjoying sex less than he did > before the TUNA procedure. Prostate problems came on gradually since > about '96. Most of the time I do not treat him specifically for his > prostate problem. I plan his treatments around getting rid of phlegm, > relaxing him, and balancing out the liver-spleen disharmony. Quite a > lot of yang ming points. His prostate was slightly enlarged and he had > an elevated PSA, which the urologist said this procedure most likely > would remedy. He states that he had no problem with getting and > sustaining erection and that his wife was having orgasm(s). The > problem, to him is that he doesn't have the same sensation that he used > to. It doesn't feel as exciting, although functionallly and > orgasmically, everything's o.k. He says his orgasms are less satisfying > because of decreased penile sensation. They have sex a couple of times > a week, which is their usual frequency. While on vacation, they have sex > more often. He seems to have a healthy relationship with his wife. > They enjoy life together. Her teen-age daughter may be a source of > aggravation. > > Anything I didn't cover? Hope this helps your understanding. Thanks > > Frances > > yulong@m... wrote: > > > Frances, > > > > While doing research for an upcoming book on > > Chinese sexual culture, we came across a large > > number of formulas that might be useful in > > this case. But before I could point you at > > one or the other, You'd need to provide > > a more complete picture of the case. > > > > Your presumption that the loss of sensation > > stems from scar tissue may or may not be > > accurate and/or complete, as the symptom you > > describe could also stem from the underlying pattern. > > > > So you should provide other pertinent details. > > > > You say he enjoys sex less. Why is that? > > What specifically contributes to his lack > > of enjoyment? Is he anxious about how he > > performs? Does he have problems getting > > or sustaining an erection? Has he become > > less or non-orgasmic? > > > > How often does he have sex? Has the frequency > > of sexual activity increased? decreased? > > > > How has this all affected his relationship > > if indeed he is in a relationship? Are > > there emotional issues with his sex partner? > > > > Again, what are the details? > > > > Like I said, there is a range of formulas > > that can be applied to cases of this category. > > I'm just curious to know a little more > > before heading for the herb cabinet. > > > > What is the condition of his prostate? > > If enlarged, how much? And how long has > > the problem been going on? When was it > > first diagnosed? Did it come on gradually > > or was the onset of symptoms more sudden? > > > > Is that what you were treating him for > > with acupuncture? > > > > I'm also curious as to why you've been > > seeing him only once a month. > > > > I also note that you mention he has no > > other major problems. Does this mean he > > is having minor problems? If so, what > > are they? > > > > Best, > > > > Ken > > > > -- In , Frances Gander <fgander@c...> wrote: > > > > A patient has had a prostate procedure called a TUNA > > (transurethral > > > > needle application), and now about 2 1/2 months later, complains > > of a > > > > decreased amount of penile sensation during intercourse. I > > suspect > > > > this is from scar tissue. By the way, the procedure didn't > > work. He > > > > is still urinating a lot and on top of that, enjoying sex less. > > He is > > > > 50 years old and, other than his prostate, has no major > > problems. He > > > > sees me for acupuncture once a month. Does anyone have any > > > > suggestions for a formula that could help him regain or improve > > penile > > > > sensation? Thanks. > > > > > > Frances > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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